In fact, PHF is the second most common upper extremity fracture in adults 65 years of age and older at which point the annual incidence is 253 per 100,000 person years. The incidence of PHF increases with age and 70.5% occur in women. Population-based studies estimate similar annual incidence rates in North America and Europe (60 and 82 per 100,000 person years, respectively). Proximal humerus fractures (PHFs) are the third most common upper extremity fracture across the lifespan. Meanwhile, consensus guidelines should be developed in the context of region-specific physiotherapy service models to inform best practice in PHF rehabilitation management. Potential implications:Multi-disciplinary collaborations to design and conduct large, high quality, multi-centre prognostic studies and RCTs that evaluate the effectiveness of key aspects of non-surgical PHF rehabilitation in various patient groups are needed. Elements used by physiotherapists in Ontario treating small numbers of individuals with Neer Group 1 or complex PHFs each year align well with the limited PHF rehabilitation literature available. ![]() Most respondents were unsure that there is sufficient PHF rehabilitation literature to guide treatment.Ĭonclusions:This environmental scan is the first North American study to document practice patterns and attitudes of physiotherapists providing PHF rehabilitation. The main factors influencing the treatment plan were the ability of the individual with PHF to comply, bone quality, and fracture type. Main findings: Physiotherapists manage PHF using multi-component interventions and a minimum of 76% include the following elements: education and progression of passive, active assisted, active range of motion exercises and muscle retraining to build coordination and strength. Most individuals with PHF were older than 60 years (64%), female (76%) and accessed physiotherapy through a doctor’s referral (91%) more than 1 month post injury (33%). Respondents treated 1-5 individuals with PHF annually more treated Neer Group 1 PHF (89%) than complex PHF (68%). ![]() Results: The response rate was low (10%) 83 physiotherapists completed the survey - 80% had experience managing PHF. Method: A paper and pencil survey asking about respondent demographics and management of Neer Group 1 (minimally/nondisplaced) and complex (displaced 3- and 4-part) PHF was mailed to 875 randomly selected physiotherapists who were registered with the College of Physiotherapists of Ontario in 2013/2014 and working in practice areas likely to be accessed by adults with PHF. Purpose: To determine practice patterns and perceptions of physiotherapists who treat adults with PHF in Ontario, Canada. Evidence-based protocols for PHF rehabilitation are lacking and physiotherapists use a variety of interventions. Keywords: Shoulder fractures Physical therapy Rehabilitation QuestionnaireĪbbreviations: AAROM: Active Assisted Range Of Motion AROM: Active Range of Motion GE Strength: Gravity Eliminated Muscle Strengthening GHJ Mob: Glenohumeral Joint Accessory Movement Mobilization Techniques PHF(S): Proximal Humerus Fracture(s) PR: Strength: Progressive Resistive Muscle Strengthening PROM: Passive Range Of Motion/Pendulum Exercisesīackground: Proximal humerus fractures (PHFs) are common injuries particularly in older adults. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Rehabilitation of proximal humerus fractures: An environmental scan of Canadian physiotherapy practice patterns. How to cite this article: Kwan LL, MacIntyre NJ. West, Hamilton, Canada, Tel: 1-90, Fax: 1-90 Email: Submitted: 19 August 2017 Approved: 19 September 2017 Published: 20 September 2017 *Address for Correspondence: Norma J MacIntyre, Associate Professor, School of Rehabilitation Science, McMaster University, IAHS-403, 1400 Main St. West, Hamilton, CanadaĢAssociate Professor, School of Rehabilitation Science, McMaster University, IAHS-403, 1400 Main St. ![]() Rehabilitation of proximal humerus fractures: An environmental scan of Canadian physiotherapy practice patternsġPhysiotherapist, School of Rehabilitation Science, McMaster University, IAHS-403, 1400 Main St.
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